Posted on 04/07/2005 12:37:29 PM PDT by Coleus
Glucosamine, often recommended for joint pain, is one of the most popular supplements on the market. And considering the health concerns recently associated with nonsteroidal anti-inflammatory medications, I thought it would be worth looking into whether glucosamine lives up to the hype.
Background: Glucosamine and chondroitin are often combined together and used to treat osteoarthritis (OA), which occurs when the cartilage covering the end of the bone near the joint breaks down. OA affects the knees, backs, hips, hands and feet of more than 21 million people over age 45. And, according to Roland W. Moskowitz, M.D., professor of medicine at Case Western Reserve University's Arthritis Translational Research Program, about 90 percent of the population will suffer from OA by age 75.
The most common treatments for OA are nonprescription, nonsteroidal anti-inflammatory drugs (NSAIDs) - pain relievers like Tylenol, ibuprofen or aspirin - as well as the prescription medications Vioxx, Bextra and Celebrex, which you've probably recently heard have significant cardiovascular concerns.
The risks and limitations of these drugs have led many OA sufferers to seek alternatives, including glucosamine, which has been used as a joint therapy for more than 20 years in Europe and has more recently been gaining popularity in the United States.
What is it? Glucosamine and chondroitin sulfate are substances produced by and found naturally in the body. Glucosamine is a form of amino monosaccharide (sugar) believed to play a role in cartilage formation and repair. Chondroitin sulfate is part of a large protein molecule that gives cartilage elasticity. The glucosamine and chondroitin in supplements are extracted from animal tissue: glucosamine from crab, lobster or shrimp shells, and chondroitin sulfate from animals such as sharks.
How it works: Glucosamine is believed to stimulate and repair joint cartilage, ease pain and slow deterioration. Chondroitin fights off harmful enzymes that destroy cartilage and simultaneously helps surviving cartilage retain water and elasticity. Most research, however, is focused on glucosamine. Many experts say we don't know the specifics of how it works. But "glucosamine has been shown to reverse several of the negative effects of interleukin-1 (IL-1) on the joints. IL-1 promotes both the joint-inflammation and joint-destruction processes in osteoarthritis by activating genes that carry the message for the synthesis of pro-inflammatory mediators and tissue-destructive mediators," claims Jean-Yves Reginster, M.D., Ph.D., director, World Health Organization Collaborating Center for Public Health Aspects of Rheumatic Diseases, University of Liege, Belgium.
Does it work? None of the studies provides a definitive answer, and researchers are split. Skeptics claim current research is invalid, that conclusions are flawed due to short-term follow-ups and dismal sample sizes. Supporters stand by the promising results. Past studies show that some people with mild to moderate OA taking either glucosamine or chondroitin sulfate reported pain relief similar to that of nonsteroidal anti-inflammatories, such as aspirin and ibuprofen. Some research also indicates that the supplements might slow cartilage damage in people with OA. In fact, the Arthritis Foundation believes there is emerging evidence that glucosamine is an appropriate treatment for people with OA of the knee, providing a number of benefits, such as symptom relief, improved function and a slowdown in the progression of cartilage damage.
According to Reginster, the original crystalline glucosamine sulfate 1,500-milligram once-a-day formulation, approved as a prescription drug in Europe and available as a specific, branded nutraceutical in the United States, "has been shown to be effective (in treating OA of the knee) in two separate, long-term clinical trials of three years duration. Besides symptom control, these two trials showed that the compound was able to delay the joint structural changes as assessed mainly by radiographic measuring of joint space narrowing. This would allow glucosamine sulfate to be possibly classified as the first disease-modifying agent in osteoarthritis."
In a key review completed by the Arthritis Center of Boston University School of Medicine and reported in the Journal of the American Medical Association, the authors analyzed all available glucosamine studies, concluding, "Trials of glucosamine and chondroitin preparations for OA symptoms demonstrate moderate to large effects, but quality issues and likely publication bias suggest that these effects are exaggerated. Nevertheless, some degree of efficacy appears probable for these preparations."
However, David Felson, M.D., M.P.H., professor of medicine at Boston University School of Medicine and one of the authors, has since modified his opinion: "Most of the successful trials were funded by industry, and all three of the public, nonindustry studies have shown no impact from using glucosamine. There's a good chance we've been hoodwinked." Keep in mind, he adds, that these trials, unlike pharmaceutical trials, don't require any Food and Drug Administration approval - meaning that FDA rules and regulations don't apply.
And finally, Paul Dieppe, former professor of rheumatology and now director of the MRC Health Services Research Collaboration at the University of Bristol, England, agrees with the skeptics, writing in an editorial in the British Medical Journal that, "The reviews and meta-analyses are dominated by trials done several years ago, many of which were particularly poor, and the quality of more recent studies is clearly better. ... We conclude that there is more confusion and hype than magic about glucosamine. The rationale for its use is unclear, the best dose and route of administration unknown, and the published trials do not allow any conclusion about its efficacy (let alone its cost effectiveness)."
Yet others take a more pragmatic approach. Moskowitz, for example, says, "There's enough evidence that you can't simply dismiss glucosamine." And according to C. Thomas Vangsness Jr., M.D., a surgeon and professor at the University of Southern California Keck School of Medicine in Los Angeles, about 25 percent of glucosamine users are probably experiencing a placebo effect, meaning they feel better, but it's not caused by the glucosamine. "And that's OK, too," he adds.
One of the most important studies - the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) - is being conducted by the National Institutes of Health (NIH). This clinical trial focuses on the benefits of glucosamine for OA of the knee. In addition, the NIH trial will examine the effects of chondroitin sulfate and the combination of glucosamine and chondroitin, because in the United States glucosamine and chondroitin are frequently sold together.
Although the results will not be reported until the end of 2005, glucosamine advocates are already anticipating potential negative findings, claiming that GAIT is not testing the original glucosamine sulfate 1,500-milligram once-a-day formulation used in the other trials, but a previously untested capsule of 500 milligrams of glucosamine hydrochloride taken three times daily.
Is it safe? One thing about glucosamine no one disputes is that it's generally safe. The journal Food and Chemical Toxicology recently reviewed its effects on glucose metabolism, side effects and safety considerations and found, "Glucosamine is safe and does not affect glucose metabolism."
"It seems to be a very safe agent, and I do not discourage people from taking it," says Anisur Rahman, Ph.D., a senior lecturer in rheumatology at University College, London. There are, however, a few populations for whom it's not recommended, including women who are pregnant or breast-feeding and people with liver disease. Also, if you're allergic to shellfish, you should probably avoid it.
What's the right dose? Glucosamine advocates can't agree - some suggest 1,500 milligrams once per day; others say 500 milligrams three times per day. Glucosamine sulfate is suggested over glucosamine hydrochloride for best results. "The latter has been studied insufficiently in clinical trials, and the few studies conducted show fewer benefits than the original glucosamine sulfate," says Reginster.
And what you see isn't always what you get. An independent study by ConsumerLab.com found that some manufacturers were putting less glucosamine and chondroitin in their products than stated on the labels. Of the 25 brands tested, one-third failed. View the results at www.consumerlab.com/results/gluco.asp.
Bottom line: If you have OA, especially OA of the knee - why not try it?
Charles Stuart Platkin, a nutrition and public health advocate, is author of "The Automatic Diet" (Hudson Street Press, 2005) and founder of Integrated Wellness Solutions. Write to info@thedietdetective.com .
Useless garbage. Bextra (removed today) works far, far better.
My father, now 77, has seen great benefit from Glucosamine and Condroitin.
Yes I'm giving it a try, because an family friend, a real smart guy not given to hocus pocus swears by it, he has arthritis of the knees and he says it was recommended to it by his own doctor, who had been taking it for years himself
however I did hear recently a doctor who said, first of all you have to be diligent in taking the minimum recommended dosage every day, he said if you are going to get a positive effect, it will take about 3 months to show up and if you are one of the people it benefits, the effect starts to fade after a period of time which I thought was interesting
It's worked for my dog for 5 years. She has hip dysplasia and has been on a glucosamine preparation since she was 7. It's worked great - we haven't had to resort to NSAIDS yet (they're tough on the dogs liver so we're holding them back as a last resort).
DH also takes it for his knees. If he misses a few days his knees start to hurt again.
Great stuff, IMHO.
LQ
Ping to my favorite health supplement specialist.
Mine too : )
Now that the election is over, I can say that I had heard of the merits of raisins in gin long before that loopy tart from Fox Chapel burped about them.
Something in the raisin and something in the juniper berry (in the gin) work together to alleviate symptoms of osteoarthritis, but I don't remember exactly what.
My dog has been taking the glucosamine/chondroiten combo almost a year for arthritis and it has worked wonders on her.
say does DH take the GS-Chondritin combo?
Which brand and how much? 1500 mg a day? 3 x 500 mg
I've never seen the one a day 1500 mg pill the study talks about, that would be great hmmmm
Thanks.
I know cherries as well as celery juice are great for preventing the gout.
It's made by Schiff and I think it's a 2000 mg pill but not 100% sure. It's a big 'un, though, at least 1000 mg, and is in a brown bottle with a red and white label. I can't remember if its Glucosamine plus chondroitin, or just the glucosamine.
We both recently starting taking MSM, too - a lot of companies compound all 3 into 1 pill but since he already had other stuff separately he just bought some straight MSM pills to go with it.
I had heard MSM works on carpal tunnel so I'm trying it for that.
LQ
thanks LQ, this is the first time I heard about MSM, I'll have to look it up.....
they are horse pills huh......
I,too, am intensely sensitive to anything that smacks of snake oil. However I have been using glucosamine/chondroitin, providing a total of 1500 mg of glucosamine a day for well over a year now. The impact on my knee pain is impressive--in fact, the pain is gone.
I have tried going off the supplement and find that the pain starts to return if I do.
They have to improve the reporting on things like this.
Nothing is the cure for everybody -- nor are risks equal for everyone. For those that it works, it works 100% -- and for those it doesn't, it works 0%. It doesn't work 75% for everybody.
That's pretty much how it is with all phenomena and experiences. Yours is the 100% truth of what it is -- for you. Somebody else's is the 100% truth for them. If something is promising and nothing else is, it makes sense to give it a shot. The amazing thing is that in some people, results are even instantaneous because of their hypersensitivity -- while others may not notice the difference for months; and then they'll be the one in a million who has an allergic reaction. But that we'll back off everything that anybody has shown a toxicity to or unfavorable reaction is ludicrous -- just as maintaining that any cure must work for everyone.
I recall about ten years or so ago bringing up the glucosamine cure to my local Arthritis Foundation and being told, "Anybody who claims they have a cure for arthritis is a con artist." Now, the Arthritis Foundation's chief fund raiser is the book on alternative cures for arthritis, insisting that they wrote the book on this subject matter -- when they used to be discrediting those who did.
As one person scolded me, "Mr. H--, I don't think you understand the purpose of our organization. We're not here to cure arthritis; we're here to raise money to cure arthritis."
Mrs. B was having so much discomfort from the plate in her neck that a few months ago, she was literally kicking me out of bed every night. I suggested she switch from the more modern celebrex to old-fashioned, enteric asprin, and try glucosamine and MSM.
It's made all the difference in the world- she rests comfortably now.
The old dog (12) takes a lighter dose as well. FWIW, the vet tells us that in dogs, relief is highly individuallistic-- some behave like a much younger dog, others get no relief at all.
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